May 12, 2016

Question:
We’ve been using the transitional care management codes, 99495-99496, for post-op discharge care (e.g., writing prescriptions, dictating the discharge summary) while the patient is in the hospital after surgery for breast reconstruction or flap reconstruction procedures. Medicare has been denying the codes. Should we appeal these denials?

Answer:
No, don’t appeal the denials. Discharge care management is included in the 90-day post-operative global period for breast reconstruction and flap reconstruction procedures. The transitional care management codes have specific requirements, as noted in CPT resources, which are typically are performed by the patient’s primary care physician.

*This response is based on the best information available as of 05/12/16.